Individual provider · Type 1 NPI
Nedra G. Tidwell
Child Intellectual and/or Developmental Disabilities Respite Care · Azle, TX
Practice location
7525 Portwood Rd
Azle, TX 76020-5835
Fax (817) 444-9115
Mailing address
7529 Portwood Rd
Azle, TX 76020
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Licensed Vocational Nurse | 164X00000X | 28761 (TX) |
| Child Intellectual and/or Developmental Disabilities Respite Care Primary | 385HR2060X | 28761 (TX) |
Child Intellectual and/or Developmental Disabilities Respite Care: A facility or distinct part of a facility that provides short term, residential care to children diagnosed with intellectual and/or developmental disabilities as respite for the regular caregivers.
About NPI 1790959252
Nedra G. Tidwell's National Provider Identifier is 1790959252, issued on Apr 16, 2008. The primary taxonomy on file is Child Intellectual and/or Developmental Disabilities Respite Care (385HR2060X), and the practice location is in Azle, TX. The record was last updated on Apr 16, 2008.